Urban Health Blueprint: How Data-Driven Policy is Curing Our Cities

BETHESDA, MD – December 09, 2025 — While national politics often capture the headlines, a quiet but powerful revolution in public health is unfolding at the local level. A new 2025 assessment from CityHealth reveals that a majority of America's largest cities are successfully implementing evidence-based policies that directly improve the well-being of their residents. The report shows that 51 of the nation's 75 largest urban centers have earned a medal for their health policy frameworks, impacting the lives of 47.6 million people—an increase of nearly 4 million from just last year.

This year's findings are punctuated by Chicago's ascent into the top tier of municipal health leaders. The city earned its first-ever overall gold medal, joining an elite group of eight cities including Boston, Denver, and San Antonio. This progress, along with improvements in ten other cities, signals a growing consensus among local leaders: the most effective prescriptions for community health aren't always found in a clinic, but are often written into city code.

The New Urban Prescription: Policy as Medicine

The central philosophy driving this movement is the concept of "policy as medicine." It’s a strategic shift away from a purely reactive healthcare system toward a proactive model that addresses the root causes of illness and inequity. As the de Beaumont Foundation's President & CEO, Brian C. Castrucci, stated, "This assessment shows the impact local leaders can have when they choose policies that strengthen the foundations of health. City officials from both sides of the aisle are recognizing that policy is medicine — it’s how we build safer neighborhoods, healthier housing, and stronger futures for all."

This approach focuses on the social determinants of health—the conditions in the environments where people are born, live, learn, work, and play. CityHealth evaluates municipalities across 12 distinct policy areas that directly impact these conditions. These aren't abstract goals; they are tangible, proven interventions. They include ensuring access to Affordable Housing Trusts, designing Complete Streets that are safe for pedestrians and cyclists, guaranteeing Earned Sick Leave, promoting Greenspace, and establishing criteria for Healthy Food Purchasing in city-run facilities.

The impact of this philosophy is far-reaching. "Health doesn’t start in the clinic — it starts in the communities where people live, learn, work, and play,” noted Bechara Choucair, MD, Executive Vice President and Chief Health Officer at Kaiser Permanente, a key partner in the initiative. “By looking beyond the four walls of care and investing in policies that make cities healthier, local leaders are improving conditions for 47.6 million people." This framework redefines public health, viewing urban planners, city council members, and mayors as frontline health workers whose decisions on zoning, transportation, and labor law have profound and lasting effects on community well-being.

Data-Driven Governance: The Engine of Change

This urban health revolution is not happening by accident. It is powered by a sophisticated engine of data, research, and strategic partnership. At its core, the CityHealth assessment is a powerful application of technology and data science to the art of governance. The initiative, backed by the de Beaumont Foundation and Kaiser Permanente, leverages a rigorous methodology to create a clear, competitive, and actionable benchmark for city leaders.

The data collection and legal analysis are conducted by the Center for Public Health Law Research at Temple University’s Beasley School of Law. This partnership brings a high level of academic rigor, employing "policy surveillance" to systematically track and score municipal laws against gold, silver, and bronze standards. This process transforms complex legal codes into a clear, comparable metric of performance, allowing cities to see exactly where they stand and what steps are needed to improve.

This data-driven approach serves multiple functions. It provides a roadmap for cities seeking to adopt best practices, creates a mechanism for public accountability, and fosters a sense of "coopetition"—cooperative competition—among municipalities. When a city sees a peer move up in the rankings, it creates an incentive to investigate which policies drove that success and how they can be replicated. The annual release of the assessment acts as a catalyst, sparking conversations in city halls and empowering local advocates with the evidence they need to push for change. It is a prime example of how non-governmental organizations can leverage data to influence public policy and drive systemic improvements without direct legislative authority.

From Bronze to Gold: A Tale of Urban Progress

The 2025 assessment is filled with stories of tangible progress. The most prominent is Chicago, which moved from silver to gold status under the current policy package. This achievement is the culmination of years of strategic effort, including the city's adoption of a "Health in All Policies" framework designed to embed health and equity considerations across all government departments. This systemic approach is precisely what CityHealth aims to encourage.

Beyond the gold medalists, the momentum is widespread. Five cities—Cleveland, Columbus, Louisville, Nashville, and Oakland—graduated from bronze to silver, demonstrating significant enhancements to their policy portfolios. Another five cities earned their first-ever overall bronze medals, welcoming Austin, Cincinnati, Irvine, Phoenix, and Tulsa into the ranks of recognized health leaders. This marks a 68% medal rate among the 75 largest cities, up from 63% in 2024.

These advancements are built on concrete policy wins. In 2025, cities earned a collective 434 individual policy medals. While some policies like High-Quality, Accessible Pre-K have seen widespread adoption, the report also shows where work remains. The inclusion of policies like Legal Support for Renters and Safer Alcohol Sales highlights the comprehensive nature of the framework, pushing cities to address complex issues that are deeply intertwined with public health and safety. As CityHealth Executive Director Katrina Forrest, JD, observed, “From expanding affordable housing to improving access to greenspace, the policy momentum we’re seeing across the country is a powerful reminder that real progress starts locally.”

Navigating Headwinds: The Road Ahead for City Health

Despite the clear momentum, the path forward is not without its challenges. City leaders are navigating a complex landscape of shifting political priorities, constrained resources, and the looming expiration of federal funds that buoyed many public initiatives during the pandemic. Maintaining and expanding these health-focused policies will require new levels of innovation in financing and public-private partnerships.

Furthermore, the principle of local control, which is the very foundation of CityHealth's model, is often under threat from state-level preemption. In many regions, state legislatures actively block cities from enacting policies like raising the minimum wage, guaranteeing paid sick leave, or implementing stricter environmental regulations. This political friction can stifle local innovation and requires city leaders to be not only effective administrators but also savvy advocates for their communities' right to self-govern.

Yet, the trend toward local action remains robust. The CityHealth assessment proves that when empowered with data and a clear framework, cities can become powerful laboratories for public health innovation. The success of Chicago, Austin, and dozens of other urban centers demonstrates a replicable model for progress. As cities continue to champion policies that build healthier environments, safer communities, and more equitable opportunities, they are not just improving their own residents' lives—they are forging a new, more resilient future for the health of the nation.